Successfully Managing Chronic Health Conditions with Human

Cognizant 20-20 Insights

Digital Business Successfully Managing Chronic Health Conditions with Human- Centered Digital Therapeutics By adopting evidence-based digital therapeutics, healthcare organizations can alleviate the mounting costs of caring for the growing number of patients with chronic conditions — and enter the fourth wave of digital healthcare.

Executive Summary

Caring for individuals who suffer from chronic health While the U.S. healthcare system generally excels when conditions, such as diabetes, high blood pressure, delivering emergency and acute care, it falters when congestive heart failure (CHF) and chronic obstructive treating incurable conditions that must be managed and pulmonary disease (COPD), costs the U.S. healthcare controlled. Payers, providers and industry regulators are system billions of dollars annually. Much of this expense all too familiar with the results of ineffective management is due to ineffective management of these conditions — of chronic conditions: expensive emergency department not only by patients themselves but also by the (ED) visits, hospital admissions and, often, return ED visits healthcare system. and readmissions. Yet despite the costs and care, most

February 2019 Cognizant 20-20 Insights

patients experience minimal progress in managing behavior and adhere to prescribed therapies. In our their underlying conditions. follow-up ethnographic study, we set the goal of identifying the digital capabilities that healthcare Why does the healthcare system struggle to organizations can adopt to provide patients with effectively manage these conditions? In large part, warm care so that together, they can better manage it’s because people must change their behaviors: chronic conditions. taking medications, eating more healthfully, exercising regularly, practicing self-care — actions In this new ethnographic study, we immersed that even the healthiest of people find challenging. ourselves in the lives of patients and interviewed Rather than giving orders and expecting linear physicians at some of the largest U.S. healthcare results, health systems, physicians and caregivers systems. The study offered clear insights into the must instead support patients throughout their capabilities that patients and physicians want when journeys as they experiment with how best it comes to managing chronic conditions. Armed to manage their conditions. And payers and with these findings, we developed a prototype regulators must adopt a new and very different of a conversational AI-based digital therapeutic reimbursement model that rewards providers solution designed to assist patients with CHF. based on their ability to successfully manage This report outlines what we learned about the chronic conditions. willingness of patients and physicians to use digital Digital tools, especially rigorous digital therapeutics, therapies to manage chronic conditions such as can help the industry achieve these goals. Our CHF, and what the industry must do to incorporate landmark study “Helping People Heal” revealed digital therapeutics into its ecosystem, from the that when patients get “warm,” supportive care, care continuum to reimbursement and regulation. they’re more likely to successfully change their

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Understanding the chronically ill patient

More than 100 million people in the U.S. suffer from Our discussions included the following questions: one or more chronic healthcare conditions.1 These ❙❙ What are the biggest barriers you’ve faced in often-incurable conditions must be managed your daily activities since your diagnosis? carefully for patients to avoid disease progression and maintain a good quality of life. But despite the ❙❙ What were the major pain points during your U.S. healthcare system spending approximately hospitalization or recent doctor’s visit? 2 $3 trillion on chronic conditions annually, chronic ❙❙ What do you think of digital advances conditions persist. And despite the industry’s focus in medicine? on patient engagement, efforts to reduce the ❙❙ How ready are you to manage your medical progression and complications of chronic illness, condition yourself? especially those that are lifestyle-influenced, seem largely ineffectual. ❙❙ What does the ideal solution look like? ❙❙ How would you like technology to support Our initial study on healing revealed that patients your care? require empathic support to help manage the physical and emotional aspects of healing, and After weeks of study, we developed a patient yet the healthcare system rarely addresses these persona, Marge. Marge is a 68-year-old woman needs. Instead, the system tends to be cold and who lives by herself and is active within her linear, and focused on strict adherence. Most community. She has a history of diabetes and technological solutions mirror these tendencies; hypertension and is on several medications. that is, healthcare organizations use technology to Complications from the diabetes and hypertension streamline existing processes rather than reimagine lead to an emergency department visit, hospital processes from the patient perspective. admission and diagnosis of CHF (see QuickTake, page 5). Despite good care at the hospital and This approach has not netted the hoped-for detailed discharge instructions, within the month, outcomes in managing chronic illnesses. We set out Marge is readmitted to the hospital. Marge’s to learn more about the qualities that would make journey highlights the core patient issues that must a digital disease management tool effective for be immediately addressed through a reimagined patients and physicians. care model: To gain deep perspective, we started with an ❙❙ Lack of clear down-to-earth information ethnographic study of patients diagnosed with about the patient’s condition. Patients rarely CHF and their providers. Selected patients understand the mechanics of their conditions, spanned various socioeconomic groups. Our how several chronic conditions and treatments researchers shadowed these individuals and talked might interact, and what their prescriptions are with them at length to understand their journeys focused on accomplishing. and the friction points they experience.

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❙❙ Weak support system. Because of stringent or calls might come when the patient feels fine. privacy regulations surrounding personal health It’s in the moments when the patient “doesn’t data, providers can’t easily connect patients with feel right” — which the provider can’t predict — other individuals managing similar conditions when they most need contact. who could provide practical advice and support. ❙❙ Limited support for changing behaviors. ❙❙ Complicated prescription schedule. Adopting new long-term behaviors, such as Individuals with CHF are commonly prescribed eating healthier foods, exercising regularly or up to seven medications and take more than overcoming an addiction, is a challenge for even 10 doses a day,3 which makes it easy to forget the healthiest people. Regular encouragement a dosage. When taking several medications at for weeks or months is required to make new a time, it might be hard to pinpoint which one behaviors stick.4 caused an uncomfortable side effect, resulting ❙❙ Inability to effectively self-monitor condition. in patients choosing to skip dosages altogether, It’s difficult for an individual to distinguish especially if no one has clearly explained what between minor symptoms and more serious the pills do. ones. Given the difficulty with reaching a primary ❙❙ Lack of adequate post-discharge provider care physician quickly, frightened patients tend communication. Patients can easily miss post- to go to emergency departments. discharge phone calls from a healthcare system,

Patients described the capabilities they’d like to see for solving the problems above:

❙❙ A simple-to-use, single solution that addresses all their conditions and gives them bite-sized instructions to adhere to their complicated daily treatment routines. ❙❙ Clear information about their disease and explanations about what their medications should accomplish. ❙❙ The ability to blend medical adherence and other changes into their existing lifestyles to avoid the disease or illness becoming the focus of their lives. ❙❙ The ability to quickly reach a provider when necessary. ❙❙ Timely guidance, reassurance and feedback from providers about how well they’re managing their conditions.

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Quick Take

Marge: the journey of the chronically ill patient

We conducted an in-depth study of chronically ill patients to understand the factors preventing them from managing their conditions more effectively. Most chronically ill patients suffer from more than one chronic condition, and conditions can exacerbate one another. A person diagnosed with CHF likely has additional diagnoses of hypertension and diabetes and, on average, takes seven prescription medications.

As we talked with and followed patients in their daily routines, a clear persona of the chronically ill patient emerged. She is Marge, a 68-year-old woman who lives alone. Her journey is all too typical in the U.S. healthcare system.

Marge’s journey

Discharge Medications prescribed, and Inability to ﬁll some treatment information provided prescriptions

Diagnosis of Diﬃculty adhering to treatment congestive heart failure and dietary instructions

Acute medical� intervention is Loss of conﬁdence in the treatment provided, and patient is admitted plan and missed medication dosages

Calls 911 and is No ability to monitor taken to the ED worsening symptoms D DAY 1 AY 22 Patient experiences Patient calls 911 and shortness of breath returns to the ED Re-admitted with acute decompensated heart failure within 22 days

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❙❙ One day, Marge feels very short of breath. She calls 911; emergency responders take her to the emergency department, where Marge receives acute medical intervention. Her condition stabilizes, and she’s admitted to the hospital with the diagnosis of CHF.

❙❙ After a few days, the hospital discharges Marge, sending her home with numerous prescriptions to fill and pages of information about limiting salt intake and increasing her exercise levels. At first, she’s happy to be home. But it’s now that her real challenges begin.

❙❙ Marge isn’t immediately able to fill several of her prescriptions: Her co-pay is unaffordable for one of the medications, and the pharmacy must order the other, making a return trip necessary. She finds it confusing to remember which of her eight medicines to take when, and with what foods — or no food. She inadvertently skips dosages.

❙❙ Marge doesn’t know the sodium levels of many of the prepared convenience foods she normally eats. While she puts her salt shaker away, she doesn’t make substantial changes in her diet.

❙❙ A difficult week passes, and Marge doesn’t feel any better. She doesn’t have the energy to go for a short walk. She eats foods that comfort her, including salty chips; does not pick up her additional prescriptions; and regularly forgets to take the meds scheduled outside of her meal times.

❙❙ Marge has no monitoring equipment at home, so she doesn’t know what “normal” now is for her. She tries reaching her primary care physician but misses the returned calls from his office. When her breath again gets short, she panics and calls 911. She’s taken back to the ED. The hospital re-admits her with acute decompensated heart failure, 22 days after the initial discharge. The provider incurs a financial penalty, and Marge is miserable. There’s every indication that this cycle will repeat itself unless Marge receives meaningful intervention and engagement.

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Providers want strong patient relationships yet are wary of adding more record-keeping tasks and new steps to their workflow.

The patient’s journey from a provider’s perspective

As part of our ethnographic study, we also ❙❙ Too much of the wrong information. Providers interviewed healthcare executives, physicians, fretted about being overwhelmed with data. As nurses and social workers at major U.S. healthcare one respondent said, “Physicians get too much systems to understand their perspective on how to data, not actionable information, and this is not improve the management of chronic conditions. sustainable.” Providers want to receive only We asked: smart, actionable alerts from remote patient- monitoring solutions so they deliver the right ❙❙ What do you think are the core issues in help when it’s urgently needed. healthcare today? ❙❙ Overwhelming workflows. Providers want ❙❙ What steps have you taken to solve these issues? strong patient relationships yet are wary of ❙❙ What do you like and dislike about those steps? adding more record-keeping tasks and new ❙❙ What is your roadmap to the future? steps to their workflow. Any new data exchanges must be smoothly integrated into existing Key issues that emerged included: processes and systems.

❙❙ Lack of visibility into the patient journey. The ethnographic findings indicated that an Providers said their inability to track patient effective chronic-condition management solution, behaviors outside the hospital and between complemented by clinical treatment, would need appointments results in major gaps in care. to knit together patients and providers, provide ❙❙ Inability to provide the depth of support a support system and offer near-constant, highly required by chronically ill patients. Empathy personalized information and patient feedback. and patient-centric care are essential to helping These requirements validated the need for a digital patients manage conditions, but providers lack therapeutics-based approach to address chronic the time and resources to provide 24x7 support. conditions.

Applying digital therapeutics to chronic conditions

Digital therapeutics is a relatively new discipline Internet of Things (IoT) devices and disease of evidence-based, clinically safe, physician- management algorithms to create evidence-based prescribed disease management solutions delivered solutions. They must meet clinical safety standards via digital channels to enhance or replace and integrate smoothly into provider workflows, traditional treatments. including reimbursement cycles. The most effective digital therapeutics are designed around the needs These therapeutics differ vastly from the more than of the humans involved in the treatment, not the 300,000 health apps available to consumers, as processes of the organization. they combine connected health, telemedicine,

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Digital therapeutics represent the fourth wave nurses and providers. This model is difficult to scale of digital healthcare (Figure 1). The first wave and sustain, however, given that 60% of Americans centered on remote patient monitoring, which have at least one chronic condition,8 requiring involves providers tracking patient vital signs and continued support for months or years. intervening proactively while teaching patients to Smartphones ushered in the app revolution and manage their disease. However, this model hasn’t the third wave of digital health. Individuals today delivered on its expected value. Chronically ill can choose from hundreds of thousands of health- patients are not motivated by metrics,5 and can lose related apps. However, fewer than 1% of these interest if tools fail to keep them engaged6 or are apps are subject to randomized control trials perceived as inaccurate and/or difficult to use.7 to demonstrate efficacy.9 Further, only 36 apps The second wave of digital healthcare — virtual care account for nearly half of all downloads, and 40% and telemedicine — attempted to solve these issues have fewer than 5,000 downloads.10 Such apps by adding a human touch: encouragement from aren’t likely to easily integrate into clinical workflows.

Evolution of digital technology in healthcare

Remote Patient Monitoring RPM RPM Digital (RPM) + Telemedicine + Telemedicine + Digital Apps Therapeutics

1 2 3 4

The focus on tracking The addition of live nurse A multitude of digital apps deliver This model provides a comprehensive vital signs fails to motivate check-ins to RPM provides isolated solutions focused on solution that combines RPM with behavior change among the human touch. individual metrics. a care team, delivered via digital patients. channels. However, this model is difficult These lack clinical evidence and Does not inspire sustained to scale and sustain, as aren’t integrated with provider The solution is evidence-based, engagement. continued support is needed systems. clinically safe and modeled on proven for months and even years. approaches to behavior change. A small number of apps that deliver Success is found only in small both technology- and human- Its modular architecture enables settings of patient care. based care are successful. extensible innovations and continuous learning through AI algorithms.

The approach is both personalized to individual patients’ lifestyles and scalable to large patient populations. Figure 1

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Digital therapeutics solutions build on the strengths Digital therapies augment clinical therapies, from of earlier waves of digital technology and address prescription medications to new diets and exercise their shortcomings. They collect data and discern regiments. They address the fact that an individual’s meaning from it. These therapeutics are always ability to effectively manage a chronic condition is available, scalable and adaptable to patient moods tightly linked to behaviors shaped and influenced and progress. And they connect patients to by social, cultural and environmental factors (see providers and support groups as easily as an app Figure 2).11 and are backed by research and clinical trials with proof of efficacy.

Influences on patient behavior

Many different factors influence patient behavior. Healthcare organizations can address these using digital therapeutics built with AI and machine learning capabilities that enable them to adapt to a specific patient’s key influences.

Education & Learning Rational Choice

Social & Cultural Community Selfhood Environmental

Figure 2

Helping people change their daily habits typically Using the survey findings, we prototyped a digital requires extensive one-on-one counseling therapeutics solution specifically for patients with trained professionals12 and a great deal of suffering from CHF, an extremely complicated personalized support that the U.S. healthcare illness that costs the U.S. $30 billion annually.13 system cannot afford. We set out to explore Virtually all CHF patients have one or more new digital therapeutics that would make these chronic illnesses, as CHF often results from poor interventions less expensive, more effective and management of other chronic conditions, such as significantly easier to scale. diabetes or hypertension. Because patients wanted a single tool to manage all conditions, rather than several specialized apps, CHF was the optimal test candidate for our prototype.

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AI-driven care companion generates authentic warmth and connections

Our digital therapeutics solution prototype with patient needs, we tested it with previously explored how a conversational AI-enabled “patient hospitalized CHF patients. companion” could assist a CHF patient. The Patients held wide-ranging conversations with comprehensive illness management solution starts the AI agent in the prototype. They discussed at the point the patient is discharged from the post-diagnosis aspects of their lives, including hospital, to assist with transition of care. It enables vitals monitoring, medication adherence, provider remote patient monitoring through symptom communications, behavior and lifestyle changes, tracking as recommended by American Heart dietary habits, emotional wellness and peer Association guidelines, as well as vitals tracking support. They even ventured into topics such as through automatic synchronization with IoT dealing with anxiety and how to find a new life devices to enable timely and proactive intervention. purpose. To design empathy into the therapy, we trained Interacting with the AI agent, patients experienced the AI-based system to recognize and respond to context-driven, personalized conversations and different moods and leveraged proven behavior- received the on-demand education, motivation change models and techniques to nudge patients and support missing in their healing journey. As one through various stages of the behavior-change patient said, “With any disease, if you don’t have journey. The solution also offers patients multiple support and love, you’re done.” Patients reported secured channels of connection to providers, that these features encouraged them to commit to friends and family, as well as a vetted support new behaviors and achieve better outcomes. community. To validate the prototype’s alignment

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Digital therapeutics take root in the healthcare ecosystem

Helping chronically ill patients adopt healthier ❙❙ Provider reimbursement approval. An behaviors is only one aspect of digital therapeutics encouraging move to promote digital success. For these new therapies to thrive, they therapeutics came when The Centers for need to be tightly woven into the industry’s clinical, Medicare & Medicaid Services (CMS) finalized reimbursement and regulatory tapestry (Figure 3). a ruling in 2018 defining the use of remote patient monitoring devices as part of a CPT Only then will digital therapeutics become utilities code, 99091. This code can be billed for each that the industry can draw on to achieve its triple 30-minute segment spent interpreting remote aim of better access, improved patient outcomes patient monitoring data, one time per patient and reduced cost of care. Digital therapeutics are per month, at a reimbursement rate of $59. beginning to achieve this status, as the following Further, the charge may be billed in conjunction indicators reveal: with chronic care management, transitional care management and behavioral health integration codes already used by providers for the CHF population.14 Many providers may find that the CMS reimbursement rate, plus costs saved by Digital therapeutics in the preventing readmissions and emergency visits, healthcare ecosystem will cover their digital therapeutics investments.

Digital therapeutics must be embedded in healthcare’s ❙❙ Regulatory approval. Providers said they want regulatory and reimbursement structures for providers, clinical safety assured before they prescribe payers and patients to adopt them. digital therapeutics. As a positive development, the U.S. Food and Drug Administration (FDA) is DIGITAL THERAPEUTICS testing a digital-health software precertification program with nine companies, including Apple, Alphabet’s Verily and Pear Therapeutics.15 If Health Plan Patient Reimbursements Behavioral Health precertified, a software-as-a-medical-device Methodology (SaMD) provider might be able to fast-track premarket review or avoid the process altogether for lower-risk solutions. This precertification pilot creates an opportunity to Provider Regulatory speed the release of digital therapeutics. Clinical Integration FDA Approval

Figure 3

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The digital value proposition

With CMS and the FDA signaling acceptance ❙❙ Federally qualified health centers (FQHC). of digital therapeutics, we expect to see new Neighborhood ambulatory care clinics tend to competitors enter the market. A wide variety of have strong relationships with local chronically healthcare organizations will benefit from these ill patients. Digital therapeutics can help tools, including: these providers achieve better outcomes and avoid the higher rates of ED visits, in-patient ❙❙ Risk-sharing programs. Reimbursements for admissions and readmissions that can adversely accountable care organizations (ACOs) and affect reimbursement rates. Digital therapeutics population health management programs tools can also help FQHCs meet several of the depend on the ability to meet the Healthcare wellness quality metrics that require a direct Effectiveness Data and Information Set patient-intervention channel. (HEDIS) measures established by the National ❙❙ Committee for Quality Assurance (NCQA). Insurance companies. Digital therapeutics can Digital therapeutics designed to increase care address adverse behaviors that lead chronically access, improve health outcomes and reduce ill patients to costly ED visits and hospital costs tightly align with HEDIS goals. Further, stays. Our research indicates patients using a well-designed therapeutics should enable digital therapeutics solution are more likely to risk-sharing organizations to achieve these fill prescriptions at the outset, engage more metrics with lower operating costs and, thus, effectively in their care, and understand and increased ROI. manage symptoms. These actions help decrease 911 calls, hospital admissions and 30- and 90- ❙❙ Health systems. Under the Hospital day readmission rates, as patients change diets Readmission Reductions Program (HRRP), CMS and habits. Better health means more satisfied reduces reimbursement when a hospital crosses patients and lower cost of care. its threshold for 30-day readmissions. CMS tracks CHF patient readmissions, and if more In putting digital therapeutics into practice, than 20% of patients are readmitted less than 30 healthcare organizations might first introduce a days after their initial discharge, hospitals incur digital therapy to their most seriously ill patients, financial loss. Digital therapeutics designed to such as those with CHF. They might then expand help patients manage complex conditions and the program to patients predicted to develop CHF that enable early, effective interventions in lower within a year, and then to patients diagnosed with cost settings of care will help providers reduce other chronic illnesses, such as diabetes or COPD, costs while helping patients adhere to their conditions that are often a precursor to CHF if not discharge plan, overcome barriers, enjoy better well managed. Following this timeline, risk-sharing heath and achieve a higher quality of life. organizations and providers can receive a fast return on helping the highest-risk patients while planning to keep other patients’ chronic diseases from progressing.

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Digital therapeutics: getting started

Our anthropological observation and patient study Digital therapeutics must also align with a validated the design fundamentals for effective healthcare organization’s overall strategy so they digital therapeutics. Therapies must be contextual, can drive clear clinical and business objectives. adaptable, personalized and warm while also A checklist like the one in Figure 4 can help incorporating proven treatment algorithms and organizations scope requirements for digital solid analytics and alert technologies. therapeutics and evaluate offerings accordingly.

Checklist for digital therapeutics initiatives

Goals Current Pain Points Required Features ❒❒ Reduce 30-day readmission rates ❒❒ Providing proactive patient ❒❒ EMR integration intervention ❒❒ Achieve quality metrics ❒❒ Patient feedback and ❒❒ Ensuring adherence with communication mechanism ❒❒ Improve patient engagement medication and discharge plan ❒❒ Smart vitals monitoring ❒❒ Reduce in-patient care ❒❒ Keeping up with documentation ❒❒ Evidence-based solution ❒❒ Improve effectiveness of and data churning office visits ❒❒ Clinical personnel check-in ❒❒ Providing patient education and ❒❒ Increase patient satisfaction affecting behavior change ❒❒ Support for comorbidities ❒❒ Improve outcomes ❒❒ Establishing routine ❒❒ Configurable features per patient ❒❒ Reduce overall cost of care follow-up visits ❒❒ Other ______❒ ❒❒ Other ______❒ Obtaining referrals ❒❒ Reaching patients at home ❒❒ Gaining insight into patient treatment plan adherence and challenges ❒❒ Patient barriers and social determinants of health challenges ❒❒ Other ______

Optional Features Payment Model Current Solutions ❒❒ Preventive and lifestyle coaching ❒❒ Patient health plans ❒❒ Never piloted digital medicine ❒❒ In-app video and audio ❒❒ Quality department budget ❒❒ Satisfied with current solution conferencing features ❒❒ Population health ❒❒ Current solution doesn’t close ❒❒ Integration with other home management plan gaps in care and communication assistance devices ❒❒ Multiple language support ❒❒ Integration with pharmacy to track prescription status ❒❒ Multiple treatment plan support ❒❒ Other______

Figure 4

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The medical community accepts that patient managing chronic illnesses. Digital therapeutics engagement is the key to good health outcomes. built on a behavioral science foundation and Our ethnographic studies of patients have shown validated through clinical study can result in true that when engagement is limited to appointment engagement and real behavior change that leads to scheduling, follow-up visit reminders, medication improved health outcomes at reduced cost. refills, etc., it can’t effectively help individuals

Endnotes

1 “Chronic Conditions in America: Price and Prevalence,” Rand, July 12, 2017, www.rand.org/blog/rand-review/2017/07/ chronic-conditions-in-america-price-and-prevalence.html.

2 “Health and Economic Costs of Chronic Diseases,” CDC, www.cdc.gov/chronicdisease/about/costs/index.htm.

3 “Drugs that May Cause or Exacerbate Heart Failure,” AHA Journal, Aug. 9, 2016, www.ahajournals.org/doi/pdf/10.1161/ CIR.0000000000000426.

4 “Effective Strategies for Encouraging Behavior Change for People with Diabetes,” Diabetes Management, 2015, www.openaccessjournals.com/articles/effective-strategies-for-encouraging-behavior-change-in-people-with-diabetes.pdf.

5 “Helping People Heal,” Cognizant, 2017, www.cognizant.com/whitepapers/helping-people-heal-codex2829.pdf.

6 Sara Heath, “Patient mHealth Adoption High, but Prolonged Patient Use Limited,” Patient Engagement HIT, Sept. 7, 2018, https://patientengagementhit.com/news/patient-mhealth-adoption-high-but-prolonged-patient-use-limited.

7 “Building a Better Tracker,” AARP, www.aarp.org/content/dam/aarp/home-and-family/personal-technology/2015-07/ innovation-50-project-catalyst-tracker-study-AARP.pdf.

8 “Health and Economic Costs of Chronic Disease,” CDC, www.cdc.gov/chronicdisease/about/costs/index.htm.

9 Leslie Young, “There Are Thousands of Health and Fitness Apps, and Not Much Evidence That They Work: Study,” Global News, May 18, 2018, https://globalnews.ca/news/4215969/do-fitness-apps-work/.

10 “Patient Adoption of mHealth,” IMS Institute for Healthcare Informatics, September 2015, www.iqvia.com/-/media/iqvia/ pdfs/institute-reports/patient-adoption-of-mhealth.pdf.

11 Michael P. Kelly and Mary Barker, “Why Is Changing Health-Related Behaviour So Difficult?”Public Health, Vol. 136, July 2016, www.sciencedirect.com/science/article/pii/S0033350616300178.

12 “Patient Self-Management Support Programs: An Evaluation,” Agency for Healthcare Research & Quality, November 2007, www.ahrq.gov/sites/default/files/publications/files/ptmgmt.pdf.

13 “Heart Failure Fact Sheet,” CDC, www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm.

14 Carrie Nixon, “How to Get Paid for Remote Patient Monitoring with CPT Code 99091,” Nixon Law Group, Jan. 11, 2018, www.nixonlawgroup.com/nlg-blog/2018/1/9/reimbursement-for-remote-patient-monitoring-cpt-99091.

15 “Digital Health Software Precertification Program,” FDA,www.fda.gov/medicaldevices/digitalhealth/ digitalhealthprecertprogram/default.htm.

16 Christopher M. O’Connor, “High Heart Failure Readmission Rates: Is It the Health System’s Fault?” JACC: Heart Failure, Vol 5, Issue 5, May 2017, http://heartfailure.onlinejacc.org/content/5/5/393.

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About the author

Vidya Viswanathan Venture Lead, Internal Incubator Program, Cognizant

Vidya Viswanathan is a healthcare innovator and the Venture Lead for Cognizant’s internal incubator program. She is passionate about applying human-centric solutions to business problems. She brings together strong ethnographic skills, sense-making abilities, technical acumen and design thinking to product development. In her consulting role, Vidya has helped healthcare organizations reimagine care delivery models by adopting technological innovations to improve patient and provider experiences. Vidya has a computer science engineering degree coupled with an MBA background in education. She can be reached at [email protected] | www.linkedin.com/in/vidya-viswanathan-5b75306

Acknowledgments

The author would like to thank Cary Oshima, VP of Digital Health, and Sashi Padarthy, AVP of Healthcare Consulting, for their valuable mentorship that helped shape this report. The author would also like to thank Peter Borden, CDO of Healthcare, Ryan Doyle, Head of Idea Couture Health and VP of Strategy, and the entire Cognizant Accelerator team for their insightful contributions throughout the research, ideation, product design and development that led to this paper.

15 / Successfully Managing Chronic Health Conditions with Human-Centered Digital Therapeutics About Cognizant Digital Business Cognizant Digital Business helps our clients imagine and build the Digital Economy. We do this by bringing together human insight, digital strategy, industry knowledge, design, and new technologies to create new experiences and launch new business models. For more information, please visit www.cognizant.com/digital or join the conversation on LinkedIn.

About Cognizant Cognizant (Nasdaq-100: CTSH) is one of the world’s leading professional services companies, transforming clients’ business, operating and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build and run more innovative and efficient business- es. Headquartered in the U.S., Cognizant is ranked 195 on the Fortune 500 and is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com or follow us @Cognizant.

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